Left ventricular assist devices (LVADs) may require subsequent pump exchange due to device thrombosis or thromboembolism. A limited left thoracotomy may offer advantages over standard full sternotomy in redo procedures by preserving pristine median access and decreasing the potential for re-entry injuries, postoperative bleeding and transfusion requirements. We describe repeat LVAD exchange via the left limited thoracotomy with outflow graft anastomosis to the left subclavian artery with the correction of LVAD inflow cannula angulation following recurrent LVAD thromboses.